How Hospital Gardens Help Patients Heal

To get an inkling of what a well-designed hospital garden can mean to a seriously ill child, watch the home video posted on YouTube last August of Aidan Schwalbe, a three-year-old heart-transplant recipient. The toddler is shown exploring the meandering paths, sun-dappled lawn and gnarled roots of a branching shade tree in the Prouty Garden at Children’s Hospital Boston. “He loves to be out in the garden feeding the birds and squirrels,” wrote Aidan’s grandmother in an August blog entry. “They will all weigh 30 lbs. each by the time we leave here!”

The garden that Aidan loves—with its vibrant greenery, shaded places to sit and walk, and small, half-hidden animal sculptures that fascinate visitors of all ages—is “one of the most successful hospital gardens in the country,” says Clare Cooper Marcus, an emeritus professor in landscape architecture at the University of California, Berkeley.

Dismissed as peripheral to medical treatment for much of the 20th century, gardens are back in style, now featured in the design of most new hospitals, according to the American Society of Landscape Architects. In a recent survey of 100 directors and architects of assisted-living residences, 82 percent agreed that “the design of outdoor space should be one of the most important considerations in the design.” But can gardens, in fact, promote healing? It turns out that they often can. Scientists around the world are now digging into the data to find out which features of gardens account for the effect.

Common Sense Put to the Test
The notion that the fresh breezes, dappled sunlight and fragrant greenery of a garden can be good for what ails us has its roots in ancient tradition and common sense. But a much cited study, published in 1984 in the journal Science by environmental psychologist Roger Ulrich, now at Texas A&M University, was the first to use the standards of modern medical research—strict experimental controls and quantified health outcomes—to demonstrate that gazing at a garden can sometimes speed healing from surgery, infections and other ailments.

Ulrich and his team reviewed the medical records of people recovering from gallbladder surgery at a suburban Pennsylvania hospital. All other things being equal, patients with bedside windows looking out on leafy trees healed, on average, a day faster, needed significantly less pain medication and had fewer postsurgical complications than patients who instead saw a brick wall.

Esther Sternberg, a physician and neuroimmunologist at the National Institute of Mental Health, calls Ulrich’s work “groundbreaking.” At the time, studies showing that loud sounds, disrupted sleep and other chronic stressors can have serious physical consequences were only just beginning. “In 1984 we all took it for granted that hospitals were noisy, smelly, disorienting mazes,” says Sternberg, who details the history in her book Healing Spaces: The Science of Place and Well-Being. “But it hadn’t occurred to us that stress could affect a patient’s healing—or that we could do anything about that.”

Fortunately, as the evidence implicating hospitals as major engines of stress builds, the stack of data suggesting that gardens and planted alcoves can encourage healing has grown, too. Just three to five minutes spent looking at views dominated by trees, flowers or water can begin to reduce anger, anxiety and pain and to induce relaxation, according to various studies of healthy people that measured physiological changes in blood pressure, muscle tension, or heart and brain electrical activity.

Indeed, the benefits of seeing and being in nature are so powerful that even pictures of landscapes can soothe. In 1993 Ulrich and his colleagues at Uppsala University Hospital in Sweden randomly assigned 160 heart surgery patients in the intensive care unit to one of six conditions: simulated “window views” of a large nature photograph (an open, tree-lined stream or a shadowy forest scene); one of two abstract paintings; a white panel; or a blank wall. Surveys afterward confirmed that patients assigned the water and tree scene were less anxious and needed fewer doses of strong pain medicine than those who looked at the darker forest photograph, abstract art or no pictures at all.